PURPOSE: To evaluate different calculation approaches for toric intraocular lens (IOL) calculation in cases with high posterior corneal astigmatism (PCA). METHODS: Consecutive patients who underwent cataract extraction with implantation of toric IOLs by a single surgeon were reviewed. Eyes with measured PCA of 0.80 diopters (D) or greater were included. Errors in the predicted postoperative refractive astigmatism were calculated for the Abulafia-Koch formula, vector summation of anterior keratometry with posterior tomography, and the Barrett toric calculator using predicted and measured PCA. RESULTS: One hundred seventy-three consecutive cases of toric IOL implantation were reviewed. Seventeen eyes (10%) had PCA of 0.80 D or greater and were investigated. The mean absolute error was the lowest with Barrett's measured PCA (0.55 ± 0.38) followed by Barrett's predicted PCA mean absolute error (0.65 ± 0.31), vector summation (0.69 ± 0.33), and the Abulafia-Koch formula (0.80 ± 0.36). The rate of eyes with prediction errors within 0.25 D or less was the highest for Barrett's measured PCA (29.4%) followed by Barrett's predicted PCA (5.9%) and no eyes for the Abulafia-Koch formula and vector summation. The mean centroid prediction errors were lowest for Barrett's measured PCA and Barrett's predicted PCA (0.14 ± 0.66 @70, 0.14 ± 0.73 @179, respectively), followed by vector summation (0.35 ± 0.70 @5), and the Abulafia-Koch formula (0.39 ± 0.80 @179). CONCLUSIONS: The results suggest that in cases of high PCA, the Barrett toric calculator using direct measurements of PCA may have a potential advantage over predicted PCA in toric IOL calculations and vector summation of the anterior and posterior corneal astigmatism. [ J Refract Surg . 2020;36(12):820–825.]

Purpose: To compare the accuracy of the Barrett toric calculator with measured and predicted posterior corneal astigmatism (MPCA and PPCA, respectively), the Abulafia-Koch (AK) formula, and the toric Kane formula. Setting: Ein-Tal Eye Center, Tel-Aviv, Israel. Design: Retrospective cohort. Methods: Consecutive cases of patients who underwent uneventful cataract extraction surgery with implantation of a toric intraocular lens between March 2015 and July 2019 were retrospectively reviewed. 1 eligible eye from each patient was included. The predicted postoperative refractive astigmatism was calculated using each method and compared with the postoperative refractive astigmatism to give the prediction error. Results: 80 eyes of 80 patients were included in this study. The mean centroid and the mean and median absolute prediction errors using Kane (0.25 diopters [D] ± 0.54 @ 6 degrees, 0.50 D ± 0.31 and 0.45 D, respectively) were significantly different compared with MPCA (0.12 D ± 0.52 @ 16 degrees, P < .001, .44 D ± 0.28 and 0.36 D, P = .027, respectively), PPCA (0.09 D ± 0.49 @ 12 degrees, P < .001, .41 D ± 0.27 and 0.35 D, P < .001, respectively), and AK (0.11 D ± 0.49 @ 11 degrees, P < .001, .42 D ± 0.27 and 0.35 D, P = .004, respectively). No significant differences were found between the calculators in the predictability rates within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D. Conclusions: The measured posterior corneal curvature in the Barrett calculator yielded comparable outcomes to its prediction by the Barrett and AK formulas. The Kane calculator showed a slight against-the-rule prediction error compared with the other methods, resulting in a small higher median absolute error with marginal clinical importance.

In this study, we retrospectively evaluated the deviation from the planned axis of 3 Toric intraocular lenses (TIOL). Included in the study 190 eyes, operated by two surgeons using two different manual marking techniques. The patients were implanted with either AcrySof IQ Toric SN6AT (Alcon) (n = 90), POD FT (PhysIOL) (n = 50), or TECNIS Symfony Toric (J&J) (n = 50). At least 1 month postoperatively, the IOL was photographed, and the axis was measured using a designed software. The difference between the planned and actual axis was defined as axis deviation. The effect of IOL type, astigmatism direction, and marking techniques on the average degree and direction of the IOL deviation were evaluated and compared. There was no significant difference in the average deviation between the IOLs (TECNIS Symfony: 4.03° ± 4.34, POD FT: 3.52° ± 3.38, and SN6AT: 4.24° ± 4.10), and its direction (55.8%, 39.0%, and 56.6% clockwise (CW) deviation, respectively). With the rule, astigmatism had significantly more CW deviation compared with against the rule and oblique astigmatism (64.3%, 43.8%, and 41.7%, respectively, P = 0.027), but the average deviation was similar. The marking techniques did not influence the degree or direction of the deviation.

Purpose: To describe our results with the AssiAnchor capsule device in cases of subluxated crystalline lenses. Methods: This was a retrospective consecutive case series. Seven eyes of four patients with subluxated crystalline lenses underwent lensectomy/phacoemulsification with intraocular lens (IOL) implantation using the AssiAnchor capsule device in the Kaplan medical center, ophthalmology department. Three patients had Marfan syndrome and one patient had experienced blunt trauma. Demographic data were collected as well as parameters of pre- and postoperative distance visual acuity and refraction, intra-, and postoperative complications, and IOL stability and centration. Results: Six out of the seven surgical procedures were uneventful with in-the-bag implantation of the IOL. In the first surgery, a tear of the capsular bag lead to IOL exchanging and fixating to the AssiAnchor and to the iris. In the traumatic cataract case, two AssiAnchors were used. A capsular tension ring was implanted in six out of seven surgeries. The average follow-up time was 9.5 ± 6.8 months. All the IOLs were stable and well centered except for the first IOL that exhibited a slight temporal, but not clinically significant, decentration. The distance visual acuity and the refractive parameters improved significantly in all cases. Conclusion: We found the AssiAnchor capsule device an effective tool with a short learning curve for treating subluxated lenses.